Diagnostic performance of 64-slice computed tomography coronary angiography to detect significant coronary artery stenosis

OBJECTIVE: We aimed to determine the diagnostic accuracy of 64-slice multi-slice computed tomography (MSCT) to detect significant coronary artery stenosis with comparison to conventional coronary angiography (CCA). METHODS: In 100 patients (70 men, average age 58 +/- 10 years and age range 31-75 years) scheduled to have conventional coronary angiography, MSCT was performed before catheterization (within 2 months). All patients were in sinus rhythm, able to hold breath for 15 seconds, and had serum creatinine levels < 1.5 mg/dl. MSCT scans were analysed by a radiologist and a cardiologist. Sensitivity, specificity, positive and negative predictive values for the detection of significant stenoses by MSCT in comparison with CCA were calculated on patient, vessel, and segmental bases. RESULTS: 64-slice computed tomography is able to detect significant coronary artery stenosis on a segmental basis with a sensitivity of 88% and specificity of 99% when compared with CCA. All patients with significantly stenotic coronary artery disease are correctly diagnosed. The presence of significant stenosis was correctly diagnosed by MSCT in 126 of 144 segments. Twelve non-significant lesions on CCA were overestimated by MSCT. On vessel-based analysis, the sensitivity and specificity of MSCT for detecting significant stenosis were 91% and 97%, respectively. CONCLUSION: Our results indicate that 64-slice computed coronary angiography is a reliable diagnostic modality for the detection of significant coronary artery stenosis in patients with sinus rhythm and scheduled to have CCA, but still has limitations of diagnostic performance on a per-segment and per-vessel basis.     

Long-term (3-5 years) clinical and angiographic follow-up results of coronary stenting in elderly patients.

The early and late results of percutaneous transluminal coronary angioplasty in elderly patients are well known, but although stent implantation has become the most frequent percutaneous coronary intervention in many centers, little information exists about its long-term outcome in elderly patients. The aim of this study was to evaluate the long-term clinical and angiographic follow-up results of intracoronary stenting in a study cohort of 120 patients (92 male) over 65 years of age, who underwent successful coronary stenting between June 1995 and December 1997. The target coronary artery was 48% left anterior descending, 21% circumflex and 31% right coronary artery. Stent implantation was elective in 54%, suboptimal in 32% and bailout in 14% of the patients. Long-term (34+/-14 months) clinical and angiographic follow-up was completed in 78% and 56% of the patients, respectively. The following end-points were considered: death, non-fatal myocardial infarction (MI), target and non-target lesion revascularization. Angiographic restenosis was detected in 31% of the patients. During the long-term follow-up period, 14% of the patients died and 11% developed a new MI. Target lesion revascularization was done in 19.4%, non-target lesion revascularization was done in 21%, and the survival rate was 86%. Although the restenosis rates did not deviate greatly from the expected long-term figures in younger populations, they do indicate that the potential for major cardiac events is still high among elderly subjects, in spite of developments in stent technology and medication.     

Effectiveness of sirolimus-Eluting stent implantation for coronary narrowings <50% in diameter

The long-term efficacy of percutaneous coronary intervention for mildly obstructive coronary narrowings is limited by the occurrence of restenosis, limiting the applicability of this therapy for these lesions. The present study reports on a consecutive series of 20 patients treated with sirolimus-eluting stent implantation for 23 angiographically mild de novo lesions (defined as a diameter stenosis <50% by quantitative coronary angiography). At a mean follow-up of 399 +/- 120 days, the survival-free of major adverse events was 95%, with no patient requiring target lesion revascularization.     

Malignant mesothelioma due to environmental exposure to asbestos: follow-up of a Turkish cohort living in a rural area

STUDY OBJECTIVES: This study examines the incidence of malignant pleural mesothelioma (MPM) in a rural population of Turkey with environmental exposure to asbestos-contaminated soil mixtures (white soil). DESIGN: A field-based epidemiologic study. SETTING AND SUBJECTS: A cohort of villagers (the "Eskisehir" cohort) from 11 villages around Eskisehir in central Anatolia, who had been environmentally exposed to asbestos due to the use of white soil. MEASUREMENTS: The mineral content and asbestos contamination of the white soil used in these villages was determined, as well as airborne fiber concentrations. Cohort members' details of age, sex, ambient exposure data, duration of residence in the villages, and hospital records, including pathologic diagnosis, were recorded. RESULTS: The Eskisehir cohort consisted of 1,886 villagers. During the observation time, 377 deaths occurred and 24 MPM cases were diagnosed. Average annual mesothelioma incidence rates were 114.8/100,000 for men and 159.8/100,000 for women. CONCLUSIONS: These data indicate that the risk of mesothelioma is 88.3 times greater in men and 799 times greater in women, respectively, in comparison to world background incidence rates.     

Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions.

AIMS: The aim of this study is to compare the efficacy of sirolimus-eluting stents (SES) on neointimal growth and vessel remodelling for in-stent restenosis versus de novo coronary artery lesions using serial intravascular ultrasound (IVUS). METHODS AND RESULTS: The study population consisted of 86 patients with in-stent restenosis (ISR) (n=41) or de novo lesions (n=45) treated with SES and evaluated by IVUS post-procedure and at follow-up. One 18-mm SES was used for de novo lesions while 16 patients with ISR received >1SES (total stented length 17.9 mm vs 22.0 mm respectively; P=0.004). At follow-up, no differences were observed between the ISR and de novo groups with respect to changes in the mean external elastic membrane (1.7% vs 1.3%; P=0.53), plaque behind the stent (1.2% vs 3.4%; P=0.49), and lumen areas (0.7% vs 1.9%; P=0.58). No positive remodelling or edge effect was observed. A gap between stents was observed in two patients with ISR, where more prominent, though non-obstructive, neointimal proliferation was noted. CONCLUSION: Sirolimus-eluting stenting is equally effective at inhibiting neointimal proliferation in de novo and ISR lesions without inducing edge restenosis or positive vascular remodelling.     

Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry

OBJECTIVES: This study evaluated the early outcomes of patients with acute coronary syndromes (ACS) treated with sirolimus-eluting stents (SES). BACKGROUND: The safety of SES implantation in patients with a high risk for early thrombotic complications is currently unknown. METHODS: Sirolimus-eluting stents have been utilized as the device of choice for all percutaneous procedures in our institution, as part of the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. After four months of enrollment, 198 patients with ACS had been treated exclusively with SES (64% of those treated in the period) and were compared with a control group composed of 301 consecutive patients treated with bare stents in the same time period immediately before this study. The incidence of major adverse cardiac events (MACE) during the first month was evaluated (death, nonfatal myocardial infarction [MI], or re-intervention). RESULTS: Compared with control patients, patients treated with SES had more primary angioplasty (95% vs. 77%; p < 0.01), more bifurcation stenting (13% vs. 5%; p < 0.01), less previous MI (28% vs. 45%; p < 0.01), and less glycoprotein IIb/IIIa inhibitor utilization (27% vs. 42%; p < 0.01). The 30-day MACE rate was similar between both groups (SES 6.1% vs. control patients 6.6%; p = 0.8), with most complications occurring during the first week. Stent thrombosis occurred in 0.5% of SES patients and in 1.7% of control patients (p = 0.4). In multivariate analysis, SES utilization did not influence the incidence of MACE (odds ratio 1.0 [95% confidence interval: 0.4 to 2.2]; p = 0.97). CONCLUSIONS: Sirolimus-eluting stent implantation for patients with ACS is safe, with early outcomes comparable with bare metal stents.     

Fate of side branches after coronary arterial sirolimus-eluting stent implantation

The sirolimus-eluting stent (SES) is emerging as a potential solution for the prevention of restenosis. Although the outcome of side branches after stenting with an uncoated metal stent (UMS) has been reported, the fate of side branches after SES implantation is unknown. Furthermore, the absence of spontaneous recanalization of occluded side branches following intracoronary brachytherapy has been previously described and has been related to a delayed healing process. We assessed the procedural and 6-month follow-up angiograms of 238 patients enrolled in the RAVEL study, a double-blind controlled trial of the SES versus the UMS. Any side branch seen on the preprocedure angiogram and subsequently covered by the stent was evaluated. The side branch Thrombolysis In Myocardial Infarction (TIMI) flow grade was assessed at baseline and at follow-up by 2 observers. One hundred twenty-eight patients with > or =1 side branches were identified (63 patients in the SES group with 118 side branches, 65 patients in the UMS group with 124 side branches). Side branch occlusion occurred after stenting in 12 branches (10%) in the SES group and in 9 branches (7%) in the UMS group (p = NS). Of these occluded branches, spontaneous recanalization was observed in 11 branches (92%) in the SES group and in 6 branches (67%) in the UMS group at follow-up angiography (p = NS). Thus, the fate of side branches after SES implantation is favorable and at least as good as after UMS implantation.